Organization
YOUNGSIK MOON, M.D., P.A.
Active
Other names
Hollywood Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BETTY ANN QUADE (BUSINESS MANAGER)
(301) 373-2116
Entity
Organization
Contact information
Practice address
24435 MERVELL DEAN RD, HOLLYWOOD, MD 20636-2712
(301) 373-2116
(301) 373-5281
Mailing address
24435 MERVELL DEAN RD, PO BOX 37, HOLLYWOOD, MD 20636-2712
(301) 373-2116
(301) 373-5281
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
208600000X
Surgery Physician
D09178
MD
208D00000X
General Practice Physician
D09178
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1010188
AETNA HMO
—
01
—
112048
AMERIGROUP
MD
01
—
1307
CAREFIRST BCBS OF DC
DC
01
—
145464300
OWCP
—
01
—
2120400
CIGNA
—
05
—
531541700
—
MD
01
—
5972624
AETNA PPO
—
01
—
818489
MAMSI
—
01
—
DG3783
RAILRAOD MEDICARE
MD
01
—
KQ75
CAREFIRST BCBS OF MD
MD
Enumeration date
05/17/2007
Last updated
03/24/2011
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